Spinal cord neuroablative procedures for intractable midline pain have been limited in application because of frequent side effects and disabilities caused by manipulation of adjacent normal structures during the operation. The carbon dioxide laser, with its ability to execute microneurosurgical procedures without such manipulation, presents an opportunity to minimize adverse effects while still interrupting the desired pain-conducting fibers. Commissural myelotomy with the carbon dioxide laser in a patient suffering from pain due to nonmalignant disease and with a preoperatively intact spinal cord is described.